Barequet Dana, Tur-Sinai Aviad, Barequet Irit
Department of Management, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel.
Department of Economics and Management, The Max Stern Yezreel Valley College, 1930000, Yezreel Valley, Israel.
Isr J Health Policy Res. 2019 Jan 17;8(1):13. doi: 10.1186/s13584-019-0286-8.
The Israel Ministry of Health enacted regulations that aim to reduce private expenditure on healthcare services and mitigate social inequality. According to the modified rules, which went into effect in the second half of 2016, patients who undergo surgery in a private hospital and are covered by their healthcare provider's supplemental insurance (SI) make only a basic co-payment.The modified regulations limited the option of self-payment for advanced devices not covered by national health basket, meaning that patients for whom such devices are indicated had to pay privately for the entire procedure. These regulations applied to all medical and surgical devices not covered by national health insurance (NHI).Toric intraocular lenses (IOLs) are a case in point. These advanced lenses are implanted during cataract surgery to correct corneal astigmatism and, in indicated cases, obviate the need for complex eyeglasses postoperatively. Toric IOL implantation has been shown to be highly cost-effective in both economic and quality-of-life terms. Limitations of the use of these advanced IOLs threatened to increase social inequality.In 2017, further adjustments of the regulations were made which enabled supplemental charges for these advanced IOLs, performed through the SI programs of the healthcare medical organizations (HMOs). Allowing additional payment for these lenses at a fixed pre-set price made it possible to apply a supplemental part of the insurance package to the surgery itself. In mid 2018 these IOLs were included without budget in the national health basket, allowing for self-payment for the additional cost in addition to the basic coverage for all patients with NHI.This case study suggests that, in their efforts to enhance health care equity, policymakers may benefit if exercising due caution when limiting the extent to which SI programs can charge co-payments. This is because, when a service or product is not available via the basic NHI benefits package, limiting SI co-payments can sometimes result in a boomerang effect - leading to an increase in inequality rather than the sought-after decrease in inequality.
以色列卫生部颁布了旨在减少医疗服务私人支出并缓解社会不平等的法规。根据2016年下半年生效的修订规则，在私立医院接受手术且由其医疗服务提供商的补充保险（SI）承保的患者只需支付基本的共同支付费用。修订后的法规限制了对国家健康保险篮子未涵盖的先进设备进行自付的选择，这意味着需要此类设备的患者必须自行支付整个手术费用。这些法规适用于所有未纳入国家健康保险（NHI）的医疗和手术设备。
散光人工晶状体（IOL）就是一个例子。这些先进的晶状体在白内障手术期间植入，以矫正角膜散光，在特定情况下，还可避免术后佩戴复杂眼镜的需要。从经济和生活质量方面来看，散光人工晶状体植入已被证明具有很高的成本效益。对这些先进人工晶状体使用的限制可能会加剧社会不平等。
2017年，对法规进行了进一步调整，允许通过医疗组织（HMO）的补充保险计划对这些先进人工晶状体收取补充费用。允许以固定的预设价格为这些晶状体额外付费，使得可以将保险套餐的补充部分应用于手术本身。2018年年中，这些人工晶状体被无预算地纳入国家健康保险篮子，除了为所有NHI患者提供基本保险外，还允许对额外费用进行自付。
本案例研究表明，政策制定者在努力提高医疗公平性时，如果在限制补充保险计划收取共同支付费用的程度时谨慎行事，可能会有所裨益。这是因为，当一项服务或产品无法通过基本的NHI福利套餐获得时，限制补充保险的共同支付有时可能会产生适得其反的效果——导致不平等加剧，而不是实现所追求的不平等减少。
